A New Invasion Score for Determining the Resectability of Pancreatic Carcinomas with Contrast-Enhanced Multidetector Computed Tomography

Klauß, Miriam; Mohr, A.; Tengg-Kobligk, Hendrik von; Frieß, Helmut; Singer, Reinhard; Seidensticker, Peter; Kauczor, Hans Ulrich; Richter, G. M.; Kauffmann, G. W.; Grenacher, Lars

doi:10.1159/000128557

Cited by 62 publications

(44 citation statements)

References 31 publications

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“…23,24 The positive predictive value (PPV) for predicting unresectability (89-100%) is high but the PPV of computed tomography (CT) for predicting resectability (45-79%) is low. 25,26 Pancreatic carcinoma typically manifests as a hypoattenuating focal mass relative to the enhancing pancreatic parenchyma on contrast-enhanced CT. However, approximately 11% of carcinomas are isoattenuating with the pancreas and their detection relies on secondary signs such as interruption of the pancreatic duct, distal pancreatic atrophy and mass effect.…”

Section: Standard Diagnostic Practicementioning

confidence: 99%

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Standard Diagnostic Practicementioning

confidence: 99%

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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“…Компьютерная томо-графия считается золотым стандартом в диа-гнозе рака поджелудочной железы и в оценке резектабельности опухоли в большинстве цен-тров [6]. Чувствительность КТ, по данным лите-ратуры, в оценке резектабельности рака подже-лудочной железы составляет от 81% до 96,3% [12,13,[14][15][16]. Из-за особенностей анатомиче-ского взаимоотношения поджелудочной железы и окружающих сосудов, трехмерные рекон-струкции являются полезными в представлении дополнительной информации [17,18].…”

Section: материалы и методыunclassified

Diagnostic Value of Three-Dimensional Reconstructions of Ct Images in Patients With Ductal Pancreas Adenocarcinoma

Kаrmаzаnovsky¹,

Nerestyuk²,

Кригер³

et al. 2017

Rejr

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Страница 69 ДИАГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ТРЕХМЕРНЫХ РЕКОНСТРУКЦИЙ КТ-ИЗОБРАЖЕНИЙ У ПАЦИЕНТОВ С ПРОТОКОВОЙ АДЕНОКАРЦИНОМОЙ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫКармазановский Г.Г., Нерестюк Я.И., Кригер А.Г., Хайриева А.В.ель исследования. Определить диагностическую значимость трехмерных реконструкций КТ-изображений при протоковой аденокарциноме поджелу-дочной железы. Материалы и методы. Ретроспективный анализ КТ исследований 30 пациентов с протоковой аденокарциномой поджелудочной железы. В первой группе 15 пациентам выполнили ДПЭ (дуоденопанкреатэктомия), во второй (остальные 15 пациентов) -пан-креатодуоденальную резекцию. КТ-исследование проводилось на компьютерных томо-графах Philips Brillianсе CT 64 и Brillianсе iCT 256 с применением внутривенного бо-люсного контрастного усиления. Постпроцессорная обработка осуществлялась на рабо-чей станции Brilliance Workspace Portal с помощью стандартного программного пакета "CT Viewer" с получением трехмерных моделей на основе слияния нескольких фаз ис-следования. Локализация протоковой аденокарциномы была оценена двумя рентгено-логами. Также в соответствии с бальной шкалой оценена значимость трехмерных ре-конструкций и двухмерных КТ-изображений в определении локализации опухоли и оценке сосудистой инвазии.Результаты. Чувствительность, специфичность и точностью в определении ло-кализации аденокарциномы ПЖ в 1 группе при использовании трехмерных моделей увеличились до 94%, 50%, 80%, соответственно. В соответствии с бальной шкалой ин-формативность трехмерных реконструкций в визуализации опухоли и определении ло-кализации была выше мультипланарных двухмерных изображений. Данные об инвазии сосудистой стенки были хорошо представлены в равной степени для трехмерной и двухмерной постобработки.Выводы. Постобработка КТ-изображений с получением трехмерных моделей поджелудочной железы улучшает предоперационную оценку резектабельности, позво-ляет точнее определять локализацию опухоли. Совершенствование программ трехмер-ного моделирования должно быть направлено в сторону автоматизации для внедрения в ежедневную клиническую практику.Ключевые слова: МСКТ, постпроцессорная обработка данных, трехмерное моде-лирование, протоковая аденокарцинома, локализация опухолей.

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“…Prior to the CT acquisition, patients had to drink 1 -1.5 liters of water and received 20 mg of hyoscine butylbromide i. v. (Buscopan ® , Boehringer, Ingelheim, Germany) [13]. The patients were examined with a 64-row dual-source CT (Siemens Somatom Definition Flash, Erlangen, Germany).…”

Section: Ct Imagingmentioning

confidence: 99%

Dual-Energy Perfusion-CT in Recurrent Pancreatic Cancer – Preliminary Results

Fritz

Skornitzke

Hackert

et al. 2016

Fortschr Röntgenstr

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Zusammenfassung ▼Ziel: Beurteilung der diagnostischen Eignung der Dual-Energy (DE) Perfusions-CT zur Differenzierung von postoperativen Weichgewebeformationen und Tumorrezidiven nach potentiell kurativer Pankreaskarzinomresektion. Material und Methoden: 24 Patienten nach potentiell kurativer Resektion eines Pankreaskarzinoms, die im Rahmen der regulären konventionellen Nachsorge-CT unklare postoperative Weichgewebeformationen aufwiesen, wurden prospektiv eingeschlossen. Die Untersuchung erfolgte an einem 64-Zeilen Dual-Source-CT mittels einer dynamischen Sequenz aus 34 DE-Akquisitionen alle 1,5 s (80 ml iodhaltiges Kontrastmittel, 370 mg/ml, Fluss 5 ml/s). DE Perfusions-Bilddatensätze linear gewichteter 120kVp-äquivalenter Mischbilder wurden mit einer Body-Perfusions CT-Applikation (CT Body Perfusion, Siemens Medical Solutions, Germany) zur Berechnung von Blutfluss, Permeabilität und Blutvolumen ausgewertet. Die Diagnose wurde mittels histologischer Sicherung (n = 4) bzw. durch weitere, reguläre Verlaufskontrollen bestätigt. Ergebnisse: Bei 15 Patienten wurden Rezidive eines Pankreaskarzinoms diagnostiziert, 9 Patienten zeigten unspezifische Weichgewebeformationen. Der auf Basis gewichteter, 120kVp-äquivalenter DE Perfusions-Bilddatensätze bestimmte Blutfluss in Rezidiven tendierte zu niedrigeren Werten mit 16,6 ml/100 ml/min vs. 24,7 ml/100 ml/min im Vergleich zu den unspezifischen Weichgewebeformationen, wenn auch nicht signifikant (n.s., p = 0,06, Signifikanzniveau 0,05). Permeabilität und Blutvolumen der Rezidive waren nur geringfügig niedriger (n.s.). Schlussfolgerung: Die DE Perfusions-CT ist eine vielversprechende Methode der funktionellen Bildgebung und scheint für die Diagnostik in der Nachsorge nach Pankreaskarzinomresektion geeignet. Bislang ist nur ein Trend zu niedrigeren Perfusionswerten in Rezidiven im Vergleich zu unspezifiAbstract ▼ Purpose: To evaluate the diagnostic performance of dual energy (DE) perfusion-CT for the differentiation between postoperative soft-tissue formation and tumor recurrence in patients after potentially curative pancreatic cancer resection. Material and methods: 24 patients with postoperative soft-tissue formation in the conventional regular follow-up CT acquisition after pancreatic cancer resection with curative intent were included prospectively. They were examined with a 64-row dual-source CT using a dynamic sequence of 34 DE acquisitions every 1.5 s (80 ml of iodinated contrast material, 370 mg/ml, flow rate 5 ml/s). Weighted average (linearly blended M0.5) 120kVp-equivalent dual-energy perfusion image data sets were evaluated with a body-perfusion CT tool (see above) for estimating blood flow, permeability, and blood volume. Diagnosis was confirmed by histological study (n = 4) and by regular follow-up. Results: Final diagnosis was local recurrence of pancreatic cancer in 15 patients and unspecific postoperative tissue formation in 9 patients. The blood-flow values for recurrence tissue trended to be lower compared to postoperative tissue formation with 16.6 ml/100...

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A New Invasion Score for Determining the Resectability of Pancreatic Carcinomas with Contrast-Enhanced Multidetector Computed Tomography

Cited by 62 publications

References 31 publications

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Diagnostic Value of Three-Dimensional Reconstructions of Ct Images in Patients With Ductal Pancreas Adenocarcinoma

Dual-Energy Perfusion-CT in Recurrent Pancreatic Cancer – Preliminary Results

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